- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $977.24 / $3,388.44 / $9,120.11
| Facility | | $977.24 | $3,388.44 | $9,120.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $870.96 / $1,047.13 / $2,398.83
| Professional | | $870.96 | $1,047.13 | $2,398.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,862.09 / $1,862.09 / $2,691.53
| Facility | | $1,862.09 | $1,862.09 | $2,691.53 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,071.52 / $1,698.24 / $2,691.53
| Professional | | $1,071.52 | $1,698.24 | $2,691.53 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $602.56 / $602.56 / $2,818.38
| Facility | | $602.56 | $602.56 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $977.24 / $1,318.26 / $2,137.96
| Professional | | $977.24 | $1,318.26 | $2,137.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,513.56 / $1,513.56 / $2,290.87
| Professional | | $1,513.56 | $1,513.56 | $2,290.87 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $977.24 / $1,258.93 / $1,949.84
| Facility | | $977.24 | $1,258.93 | $1,949.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,412.54 / $1,698.24 / $1,995.26
| Professional | | $1,412.54 | $1,698.24 | $1,995.26 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,570.40 / $8,912.51 / $14,791.08
| Facility | | $2,570.40 | $8,912.51 | $14,791.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $794.33 / $1,047.13 / $1,995.26
| Professional | | $794.33 | $1,047.13 | $1,995.26 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $9,332.54 / $9,332.54 / $45,708.82
| Facility | | $9,332.54 | $9,332.54 | $45,708.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7,079.46 / $7,079.46 / $8,511.38
| Professional | | $7,079.46 | $7,079.46 | $8,511.38 |